DOJ Investigating FloridaHospital Chain.The report cites evidence that some HCA hospitals were performing unnecessary heart procedures for the sole purpose of driving up profits. According to the internal reports, some doctors allegedly made misleading statements in medical records to make it appear to subsequent reviewers that the procedures were necessary.HCA said the Civil Division of the U.S. Attorney's Office in Miami has asked for information about reviews that assess the medical necessity of some interventional cardiology services. The company also said the Civil Division of the DOJ has contacted HCA as part of a national review of whether charges to the federal government for implantable cardiac defibrillators met government criteria. The DOJ indicated it will review billing and medical records at 95 HCA hospitals.

The Company's Knowledge of Procedures Were Contained in Company Memos, E-mail Correspondence and Hearing Transcripts.Details about the procedures and the company's knowledge of them were found in thousands of pages of confidential company memos, e-mail correspondence among executives, transcripts from hearings and reports from outside consultants examined by The New York Times, as well as interviews with doctors and others. A review of the documents revealed that instead of questioning whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians' activities affected the hospitals' bottom line profits.

HCA Responds on Its Website.Prior to The New York Times story breaking, HCA posted a four-page letter on its website, explaining that The New York Times “appears to be making broad points concerning patient care provided at our company’s affiliated hospitals.”The letter is complete with two pages of charts detailing totals for certain procedures performed at HCA locations. According to the HCA letter, the decision on the necessity of some heart procedures is “the subject of much debate in the cardiology community.” It also states that based on Medicare inpatient data, trends concerning the number of cardiac catheterizations and percutaneous coronary interventions (PCIs) performed at HCA-affiliated hospitals compare closely to the rest of the nation. To see the full letter from HCA, click here.

Cardiology Procedures Played a Big Role in HCA’s Profits.Cardiology is apparently a booming business for HCA, and the profits from testing and performing heart surgeries played a critical role in the company's bottom line in recent years.Some of HCA's busiest Florida hospitals performed thousands of stent procedures each year. Medicare reimburses hospitals about $10,000 for a cardiac stent and about $3,000 for a diagnostic catheterization.Recently, doctors across the country have been slower to implant stents, instead relying on drugs to treat heart artery blockages. Medicare has also questioned the need for patients who receive cardiac stents to stay overnight at the hospital, cutting into the profitability of the procedures for many hospitals.

The Pressure is on to Root Out Medicare Fraud in All Hospitals.The need to root out Medicare fraud is high for all hospitals, but the pressure on HCA is even greater. In 2000, the company reached one of a series of settlements involving a huge Medicare fraud case with the DOJ that would eventually come to $1.7 billion in fines and repayments. The accusations, which primarily involved overbilling, occurred when Rick Scott, Florida’s current governor, was the company's chief executive. He was removed from the post by the board, but was never personally accused of wrongdoing.As part of the settlement with federal regulators, HCA signed a Corporate Integrity Agreement that extended through late 2008. It detailed what had to be reported to authorities and outlined stiffer penalties if HCA failed to do so.If there were intentional violations of such an agreement, it would mean "that a defendant, already caught once defrauding the government, has apparently not changed its corporate culture," said Michael Hirst, a former assistant U.S. attorney in California in an interview with The New York Times.To read the press release on HCA’s Corporate Integrity Agreement, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don't wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.The Health Law Firm’s attorneys routinely represent physicians, hospitals, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author:George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tuesday, August 28, 2012

A doctor in Polk County, Florida, has lost his license to practice medicine. Rather than risk having his license revoked in an administrative proceeding, the now former doctor offered to voluntarily relinquish his license. The Florida Board of Medicine voted to accept the voluntary relinquishment on Friday, August 3, 2012, according to a Lakeland Ledger article.Click here to read the entire Lakeland Ledger article.

Doctor Nabbed in Sting Operation for Allegedly Prescribing Oxycodone to Undercover Police Officers.The article states the doctor from Winter Haven was nabbed in a sting operation in 2010 after allegedly providing prescriptions for oxycodone to undercover police officers without actually performing a valid medical examination. The physician allegedly pled no contest to trafficking oxycodone and illegal delivery of a controlled substance. He is currently awaiting sentencing for his offenses, which may result in three to seven years in prison, along with five years of probation, and mental health counseling. He was also a named suspect in the deaths of five patients who allegedly overdosed on the medications. Prosecutors decided not to pursue homicide charges.

Doctor Also Faced Malpractice Investigation by the Florida Department of Health.The doctor, who practiced internal medicine, also faced a malpractice investigation by the Florida Department of Health (DOH). According to the DOH, he is accused of mismanagement of a former patient’s care. That patient allegedly developed an aggressive form of prostate cancer as a result. A subsequent doctor who treated the patient ordered a biopsy and diagnosed the patient with prostate cancer that was far advanced.To read the entire case from the DOH, click here.

Repercussions of Voluntarily Relinquishing a Medical License.We almost always counsel our clients to refrain from voluntarily relinquishing their medical licenses in such circumstances. A voluntary relinquishment of a license in the face of a pending investigation is treated, for all practical purposes, the same as a disciplinary revocation.The consequences will usually include:

1. Mandatory report to the National Practitioner Data Base (NPDB) (Note: Healthcare Integrity and Protection Data Bank or HIPDB recently folded into NPDB) which remains there for 50 years.

2. Any other states or jurisdictions in which the client has a license will also initiate action against him or her in that jurisdiction. (Note: I have had two clients who had licenses in seven other states).

3. Action to revoke, suspend or take other action against the clinical privileges and medical staff membership of those licensed health professionals who may have such in a hospital, ambulatory surgical center, skilled nursing facility, or staff model HMO or clinic.

4. The OIG of HHS will take action to exclude the provider from the Medicare Program. If this occurs (and most of these offense require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the HHS OIG.

5. If the above occurs, the provider is also automatically "debarred" or prohibited from participating in any capacity in any federal contracting and is placed on the U.S. General Services Administration's (GSA's) debarment list.

6. The U.S. Drug Enforcement Administration (DEA) will act to revoke the professional's DEA registration if he or she has one.

About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Thursday, August 23, 2012

By Cori Pope, The Health Law FirmThe July 25, 2012, issue of Medical Economics features an article written by George F. Indest III, President and Managing Partner of The Health Law Firm. The article, “Beware Legal Ramifications of Unnecessary Tests,” discusses lists that were recently released by nine medical specialty societies on medical tests and procedures patients and physicians should question or avoid.

What These Lists of Questionable Procedures May Mean for Patients and Doctors.In the article Mr. Indest provides his insights into what these lists of questionable procedures may mean for patients and doctors.Patients now have access to some of the same information as their doctors and can ask whether a test or procedure is warranted. This ability allows shared decision-making between patients and physicians and can result in less uncertainty by patients about the medical care they are receiving.

For doctors, health care clinics and hospitals, these lists could mean additional litigation for ordering “unnecessary” tests and procedures for their patients.To read the entire article, click here.Mr. Indest's Background.

Mr. Indest is a well-known attorney specializing in the representation of health professionals and healthcare providers throughout Florida. He is Board Certified by The Florida Bar in the legal specialty of Health Law. His practice encompasses all aspects of health law, including malpractice defense, qui-tam or “whistle-blower” and false claims, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, clinical privileges hearings, representation of medical students, and other matters of healthcare law and legal representation of healthcare professionals.

In 1999, Mr. Indest started The Health Law Firm, which has three Florida offices located in Altamonte Springs, Orlando, and Pensacola. A former Navy JAG Corps attorney, he has practiced law for more than 30 years.For more information about The Health Law Firm, visit http://www.thehealthlawfirm.com.

Contact Health Law Attorneys Experienced in the Representation of Health Care Providers and Professionals.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tuesday, August 21, 2012

The investigation of a complaint which could lead to the revocation of an osteopathic physician's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the osteopathic physician who receives it. Yet, in many cases, attorneys are consulted by osteopathic physicians after the entire investigation is over, and they have attempted to represent themselves throughout the case. Often, the mistakes that have been made severely compromise an attorney's ability to achieve a favorable result for the osteopathic physician.

These are the 25 biggest mistakes we see in the osteopathic medicine cases we are called upon to defend after a DOH investigation has been initiated:

1. Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2. Contacting the DOH investigator and providing him/her an oral statement or oral interview. (Note: There is no legal requirement to do this.)

3. Making a written statement in response to the "invitation" extended by the DOH investigator to do so. (Note: There is no legal requirement to do this.)

4. Failing to carefully review the complaint to make sure it has been sent to the correct osteopathic physician. (Note: Check name and license number).

5. Failing to ascertain whether or not the investigation is on the "Fast Track" which may then result in an emergency suspension order (ESO) suspending the osteopathic physician's license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with PRN instructions.)

6. Providing a copy of the osteopathic physician's curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so. (Note: There is no legal requirement to do this.)

7. Believing that if they "just explain it," the investigation will be closed and the case dropped.

8. Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.

9. Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

10. Delegating the task of providing a complete copy of the patient medical record to office staff, resulting in an incomplete or partial copy being provided.

11. Failing to keep an exact copy of any medical records, documents, letters or statements provided to the investigator.

12. Believing that the investigator has knowledge or experience in medical procedures or health care matters or procedures being investigated.

13. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.

14. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

15. Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.

16. Believing that because they haven't heard anything for six months or more the matter has "gone away." The matter does not ever just go away.

17. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

18. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.

19. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.

20. Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.

21. Retaining "consultants" or other non-lawyer personnel to represent them.

22. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.

23. Attempting to defend themselves.

24. Believing that because they know someone with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

25. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

Bonus Point: 26. Communicating with the Department of Health about the pending case.

Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed. There will be a few where the allegations made are not "legally sufficient" and do not constitute an offense for which the osteopathic physician may be disciplined.

In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH attorney to recommend a dismissal to the Probable Cause Panel. In other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing. The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Osteopathic Physicians.

The attorneys of The Health Law Firm provide legal representation to osteopathic physicians in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.About the Author:Christopher E. Brown, J.D. is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

Thursday, August 16, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The North Carolina Department of Health and Human Services (DHHS) announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. The DHHS has already referred 35 cases totaling $21 million to the special Medicaid Investigations Unit of the North Carolina Attorney General’s office.

The software program can allegedly detect billing behaviors that suggest fraud and can point to other related providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.

Thirteen of the referred Medicaid providers were in Wake County, four in Durham, three in Robeson and two each in New Hanover and Franklin counties. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland.

The healthcare practices were not listed by name, because they have been referred for a criminal investigation. If criminal charges are filed, the names of those being investigated would then be public record.More referrals could be forthcoming if DHHS finds more suspicious billings.

What to Do If You Are the Subject of a Medicaid Audit.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Don't Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Audits Now.

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Our attorneys have represented Medicaid providers in cases in North Carolina, South Carolina, Michigan, Florida, Mississippi and New York, among other states.

Our attorneys can represent healthcare providers in Medicare and Medicaid investigations, audits and administrative hearings in other states and jurisdictions as permitted by the rules governing attorneys in those jurisdictions.Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tuesday, August 14, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of Health and Human Services (DHHS). The 43 year-old man pleaded guilty before a U.S. district court judge to one count of conspiracy to commit health care fraud on August 2, 2012.

The Miami man was the owner of a Florida home health agency that claimed to provide home health care and physical therapy services to eligible Medicare recipients.In the first leg of the scheme, he allegedly would pay kickbacks and bribes to recruiters. In return, the recruiters would provide patients to the home health care agency. His patients, who received Medicare, were used to bill Medicare for $42 million in unnecessary home health care and therapy services, the government alleged.

The plea documents show that patients’ files were falsified to make it appear that these Medicare recipients qualified for the services when many actually did not.

Home Health Care Agency Owner Allegedly Paid Off Doctors.

The second part of this operation involved the owner of the home health agency and his accomplices allegedly paying off doctors. In this exchange, the doctors would allegedly provide the schemers home health and therapy prescriptions, and medical certifications.

Case was Investigated Bythe Medicare Fraud Strike Force.

In the end, the crimes resulted in $42 million in false and fraudulent Medicare claims that were filed between January 2006 and November 2009, according to the government. Medicare paid approximately $27 million on those false claims, according to plea documents.

As part of his plea agreement, the home health agency owner has agreed to forfeit two residential properties and cash proceeds of the fraud over to the government.

This case was investigated as part of the Medicare Fraud Strike Force. The Strike Force is a joint effort of the Department of Justice (DOJ) and the Department of Health and Human Services (DHHS) designed to combat fraud through the use of Medicare data analysis techniques.

Medicare fraud is a serious crime and is vigorously investigated by the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), state Medicaid Fraud Control Units (MFCUs) and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Thursday, August 9, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The North Carolina Department of Health and Human Services (DHHS) announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. The DHHS has already referred 35 cases totaling $21 million to the special Medicaid Investigations Unit of the North Carolina Attorney General’s office.

The software program can allegedly detect billing behaviors that suggest fraud and can point to other related providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.

Thirteen of the referred Medicaid providers were in Wake County, four in Durham, three in Robeson and two each in New Hanover and Franklin counties. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland.

The healthcare practices were not listed by name, because they have been referred for a criminal investigation. If criminal charges are filed, the names of those being investigated would then be public record.

More referrals could be forthcoming if DHHS finds more suspicious billings.

How to Respond to a Medicaid Audit.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Don't Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Audits Now.

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Our attorneys have represented Medicaid providers in cases in North Carolina, South Carolina, Michigan, Florida, Mississippi and New York, among other states.

Our attorneys can represent healthcare providers in Medicare and Medicaid investigations, audits and administrative hearings in other states and jurisdictions as permitted by the rules governing attorneys in those jurisdictions.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Tuesday, August 7, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article.

AMR Allegedly Billed More Than 300 Ambulance Trips Incorrectly.

According to the report, an in-house audit by the city showed that 323 ambulance trips out of nearly 5,000 in 2011 and 2012 had been incorrectly billed. This amounts to slightly more than six percent (6%). AMR attributes the overbilling to human error.
After concerns that the billing problems could be more widespread, it was decided the ambulance service should be audited by an independent auditor.
AMR is reported to have forgiven any outstanding incorrect balances and issued $16,000 in refunds to patients who had already paid the incorrect bills.

Patients’ Bills Allegedly 66% More Than the Amount AMR was Authorized to Charge.

Residents describe a common bill for ambulance transportation to be more than $1,000 for a single ambulance trip, which is approximately sixty-six percent (66%) more than AMR is authorized to charge under its contract with the city.

The city began its contract with AMR in January 2011, after the city's previous ambulance service went out of business. The city’s fire chief said that under AMR’s contract, the company cannot charge more than thirty-five (35%) above the Medicare rate.
AMR is allegedly cooperating in the review, but the audit will take about a month to complete.

Ambulance Services Companies Are Targets for Medicare Audits.

Recently, ambulance service companies have become the target of Medicare audits and are frequently accused of billing Medicare for unnecessary services. Medicare and Medicaid audits can result in overpayment demands reaching into hundreds of thousands of dollars and assessment of fines. Ambulance services were included in the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) work plan for fiscal year 2012 as an area that would be subject to scrutiny. Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) are launching audits of ambulance service providers and emergency medical transportation companies.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don't wait until its too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Friday, August 3, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawOn July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012.

The CMS originally announced the Recovery Audit Prepayment Review (RAPR) Demonstration Project in November of 2011 for a January 1, 2012 start date, then delayed it to June 1, 2012, then again to, “summer of 2012.”

Recovery Audit Contractors (RACs) will Review Claims with High Rates of Improper Billing.The Recovery Audit Prepayment Review allows Recovery Audit Contractors (RACs), (commonly known to attorneys representing provers as “bounty hunters) to review claims before they are paid to ensure that the provider has complied with all Medicare payment rules. RACs will conduct prepayment reviews on certain types of claims that have been found to result in high rates of improper payments. The goal is to cut improper payments before they even happen.

The Recovery Audit Prepayment Reviews will focus on seven states with high volumes of fraud and error-prone providers. These states are: California, Florida, Illinois, Louisiana, Michigan, New York, and Texas. The Recovery Audit Prepayment Reviews will also include four states with a high volume of claim with short inpatient hospital stays. These states are Missouri, North Carolina, Ohio, and Pennsylvania.

Other States May be Included in the Recovery Audit Prepayment Review Demonstration Project.

CMS is expecting that the prepayment reviews will help lower error rates by preventing improper payments instead of searching for improper payments after they occur. If these reviews are successful, other states will be included in subsequent roll-outs of the Recovery Audit Prepayment Review Demonstration.

In 2012, President Obama set three goals for cutting improper payments this year: curbing overall payment errors by $50 billion, cutting Medicare error rate in half and recovering $2 billion in improper payments, according to CMS. The prepayment review program is intended to help achieve those goals. It will also play a big part in preventing fraud, waste and abuse.

Our concerns with the widespread use of prepayment reviews are many. Prepayment reviews, especially when used where there is no indication of any fraud or a high error rate, can slow down a health provider’s cash flow to the point that it is put out of business. This is especially true for those that are predominately reimbursed by Medicare. The small business provider is at a greater risk.

In addition, the increase in professional time, salaries, copy costs, handling costs and postage greatly increase the administrative burden and the cost of doing business. To date, we have not seen or heard of any proposal by CMS to reimburse the provider for this additional unnecessary and unplanned expense.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Thursday, August 2, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law and Medical

Medical and clinical researchers, whether in an academic community or in a practice setting, spend years on clinical trials and investigations in hopes of contributing to their respective fields. Many of these researchers, however, find themselves defending their reputation after being accused of research fraud or research misconduct.

The Number of Complaints Against Researchers is on the Rise.

Although accusations of research fraud and misconduct have been present for decades, the number of complaints is on the rise, according to the FDA. In many cases, the researcher accused of such misconduct may actually be the victim of one or more unscrupulous individuals who make the complaint for his or her own ulterior motives. Some researchers may be targeted by an academic institution or the government. Other cases may involve a "whistle blower" who may just have misunderstood the situation.

Common Allegations Researchers Face.The most common accusations against researchers include: manipulating or concocting research data, failing to disclose financial interest or not properly disclosing conflict of interest, plagiarizing, failing to present data that contradicts one’s own previous research, overlooking the use of flawed data, and circumventing certain minor aspects of human-subject requirements. Researchers also face an enormous amount of pressure from funding sources. That influence on a researcher can lead to these accusations: changing the design, methodology or results of a study to meet a funding source’s expectations, ignoring details or cutting corners to meet a deadline, fabricating, falsifying or mishandling of data to gain some form of reward or benefit.Accusations can Tarnish the Reputation of the Researcher and So Much More.An accusation, even if later proven to be unfounded, may unfairly tarnish the personal and professional reputation of the researcher, cause the researcher to lose grants, bonuses and promotions, his or her employment may be terminated, or may even face criminal prosecution for fraud, theft or other applicable crimes. To learn more on clinical research fraud and misconduct, click here.

Well-KnownCases of Research Fraud and Misconduct from Around the World.One of the most notorious recent cases of research misconduct involved a stem cell researcher in South Korea who claimed to have cloned human embryonic stem cells. However, the researcher was later accused of fabricating crucial data and charged with fraud and embezzlement. The fraud charges were eventually cleared, but not before the researcher's reputation was destroyed. From 1992 to 2002 a former research professor in Vermont falsified and fabricated data in numerous federal grant applications and academic articles. He used two million dollars in government grants – taxpayer money - for studies to perpetrate his fraud. He pled guilty to falsifying 17 grant applications to the National Institutes of Health (NIH) and fabricating data in 10 of his papers. He was ordered to serve one year and a day in federal prison, permanently barred from ever receiving more federal research grants, and ordered to write letters of retraction and correction to a number of scientific journals.A prominent Massachusetts anesthesiologist admitted to fabricating 21 medical studies that claimed to show benefits from painkillers like Vioxx and Celebrex, according to the hospital where he worked. This data used in the studies was published in several anesthesiology journals between 1996 and 2008. This doctor was sentenced to six months in prison, followed by three years of supervised release. He was ordered to pay a $5,000 fine, forfeit $50,000 to the government and make $360,000 in restitution to pharmaceutical companies. The plea deal effectively ended his career as a physician.

Contact Health Law Attorneys Experienced in Clinical Research Fraud and Misconduct.The Health Law Firm and its attorneys have experience in representing researchers, investigators, academicians and clinicians who are the subject of clinical research fraud and misconduct. The Health Law Firm and its attorneys also have experience in representing students, employees, researchers, investigators and "whistle blowers" who report such matters including those who become the victim or reprisals and retaliation by the person against whom the report is made.Don't wait. Obtain the advice and counsel of experienced attorneys who are familiar with such matters and can assist you before it is too late.If you are facing research misconduct or research fraud accusations, please visit our website for more information at www.TheHealthLawFirm.com or call The Health Law Firm at (407) 331-6620 or (850) 439-1001.

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Michael L. Smith, J.D., R.R.T.is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.